不同剂量右美托咪定对无痛纤维支气管镜患者术后恶心呕吐的预防效果研究

Prophylactic Effect of Different Doses of Dexmedetomidine on Postoperative Nausea and Vomiting in Patients with Painless Fiberoptic Bronchoscopy

摘要: 目的：本研究旨在观察不同剂量右美托咪定(DEX)联合丙泊酚–舒芬太尼在无痛纤维支气管镜(FB)检查中预防术后恶心、呕吐(PONV)的效果，并探讨最佳剂量。方法：选取于2024年8月~2025年8月在内蒙古自治区人民医院行无痛纤维支气管镜治疗的患者150例，采用随机数字法将其分为3组，每组50例。三组分别给予右美托咪定0.1 μg/kg (1组)、0.15 μg/kg (2组)、0.2 μg/kg (3组)，联合0.1 μg/kg舒芬太尼及1.5 mg/kg丙泊酚进行麻醉诱导。记录并分析3组术后PONV发生率、术后VAS评分(视觉模拟评分法)、术后RSS评分(Ramsay镇静量表)、患者满意度、血流动力学指标变化、呼吸安全性指标(低氧血症、最低SpO₂)、镇痛质量指标(呛咳、体动)等。结果：三组患者一般资料、呼吸安全性指标及RSS评分比较差异无统计学意义(P > 0.05)。2组PONV发生率、术后VAS评分、呛咳与体动发生率最低，患者满意度最高(P < 0.05)。3组在T2 (过声门)、T3 (过隆突)时点的心率(HR)和平均动脉压(MAP)显著低于1、2组(P < 0.05)，且需心血管药物干预的例数(8例)显著更多(P < 0.05)。结论：在无痛纤维支气管镜检查中，0.15 μg/kg DEX (2组)可在不增加血流动力学风险的前提下显著降低PONV发生率，是较为适宜的剂量。

Abstract: Aim: This study aims to observe the effect of different doses of dexmedetomidine (DEX) combined with propofol-sufentanil in preventing postoperative nausea and vomiting (PONV) during painless fiberoptic bronchoscopy (FB) examination, and to explore the optimal dose. Methods: A total of 150 patients who underwent painless fiberoptic bronchoscopy treatment at the People’s Hospital of Inner Mongolia Autonomous Region from August 2024 to August 2025 were selected and divided into 3 groups by random number method, with 50 cases in each group. The three groups were respectively given dexmedetomidine at a dose of 0.1 μg/kg (Group 1), 0.15 μg/kg (Group 2), and 0.2 μg/kg (Group 3), combined with sufentanil at a dose of 0.1 μg/kg and propofol at a dose of 1.5 mg/kg for anesthesia induction. Record and analyze the incidence of postoperative PONV, postoperative VAS score (Visual Analogue Scale), postoperative RSS score (Ramsay sedation Scale), patient satisfaction, changes in hemodynamic indicators, respiratory safety indicators (hypoxemia, lowest SpO₂), analgesic quality indicators (choking cough, body movement), etc. in the three groups. Result: There was no statistically significant difference in general information, respiratory safety indicators and RSS scores among the three groups of patients (P > 0.05). The incidence of PONV, postoperative VAS score, the incidence of choking cough and body movement were the lowest in group 2, and the patient satisfaction was the highest (P < 0.05). The heart rate (HR) and mean arterial pressure (MAP) of group 3 at time points T2 (transglottic) and T3 (transglottic) were significantly lower than those of groups 1 and 2 (P < 0.05), and the number of cases requiring cardiovascular drug intervention (8 cases) was significantly higher (P < 0.05). Conclusion: In painless fiberoptic bronchoscopy, 0.15 μg/kg DEX (Group 2) can significantly reduce the incidence of PONV without increasing hemodynamic risk and is a relatively appropriate dose.